This service is rated as Good overall.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Good
We carried out an announced comprehensive inspection at Nuffield Health City Fitness and Wellbeing Centre as part of our inspection programme.
Nuffield Health City Fitness and Wellbeing Centre provides independent doctors GP services and treatment and comprehensive health and wellbeing screening services. Most clients receive Nuffield medical care and health assessments through their employers who are members of the Nuffield health scheme. The majority of service users receive their day to day health care from an NHS GP service. The clinic is in a large building and on the same site as a large fully equipped gym and fitness suites.
Clinical care and treatment is provided by doctors, most of whom also work in the public sector. The service has developed the role of ‘physiologists’. Physiologists employed are clinical staff with a relevant science university degree who then undertake a number of intensive clinical courses which qualifies them to be registered as a Clinical Physiologist.
Physiologists conduct the comprehensive health checks, including venepuncture for blood tests, and provide talking therapies and lifestyle coaching. Physiologists do not prescribe medicines or make clinical diagnosis.
At Nuffield Health City Fitness and Wellbeing Centre a duty doctor is available on call. At this service the physiologists are trained to use the on-site laboratory for analysing blood and other clinical samples.
This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Nuffield Health City Fitness and Wellbeing Centre provides a range of interventions, for example physiotherapy, psychotherapy and nutritionists which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.
The general manager of the service is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Nuffield Health City Fitness and Wellbeing Centre service users completed 16 Care Quality Commission feedback cards. There were no negative comments or suggestions for improvement in any cards. Comments indicated that staff were caring, treatment and support was person centred, service users trusted the opinion of the clinicians they met, the environment and facilities were clean and people felt all their needs were met. Clients also commented that they found having the clinic and gym on the same site convenient.
Our key findings were:
- Processes and systems were in place and understood by staff which would keep people safe from abuse and avoidable harm.
- Processes in place for reporting and learning from incidents were robust, ensuring that lessons were learnt, shared with staff. However, incidents were not always clearly described to ensure it was easy to identify whether the incident occurred in the gym or clinic. In addition, it was noted that two out of the four incidents recorded involved fainting, however the review of these incidents did not include whether best practice in venepuncture had been followed. There had also been a significant fall in the number of incidents reported since the previous year.
- There were reliable systems in place to protect people from unsafe premises and equipment. However, the legionella checklists for the clinic were not readily available on the day and, more action was needed to ensure the infection control policy was always adhered to by staff.
- The initial electronic health assessment provided a safety net for new clients who maybe experiencing suicidal thoughts.
- All health care assessments, treatment and advice were based on best practice guidance and the findings of the most appropriate up to date, evidence-based recommendations.
- Staff had the skills, knowledge and experience to carry out their roles effectively. However, cervical smear sample takers did not complete the additional training and refresher course recommended in best practice guidance and not all staff had completed appropriate training or guidance for dealing with sepsis, for example reception staff had not completed training available through the Royal College of General Practice website.
- The provider ensured that 1% of medical records were peer reviewed annually.
- Patients were treated with respect and dignity and their privacy was respected. Information was provided to ensure patients made informed choices about their care and treatment. Care was taken to ensure patients and clients were relaxed and at ease prior to and during their health checks.
- The service had developed links with a school to promote healthy lifestyles and wellbeing. The provider was also working with a local university to provide placements for medical students.
- There were clear and accessible complaints policies and procedures, and complaints were openly investigated and dealt with impartially.
- Leadership and management roles were well defined and staff knew who to go to for advice and support. A comprehensive major incident plan was in place and staff had completed specific training.
- Health and safety protocols and processes were well managed. Health and safety was taken seriously in particular fire safety and equipment safety. Following emergency drills the provider ensured lessons learnt were shared, improvements identified and appropriate action taken.
- Governance arrangements included reviewing and acting on the experiences of people who used the service and reviewing the satisfaction of staff and other stakeholders.
- The registered manager used processes in place to promote effective communication between the local service and the Nuffield Health head office.
- The leadership at Nuffield City Fitness and Wellbeing was conversant with the providers vision and strategy and took steps to share this with all staff.
- The registered manager, medical, clinical and estate staff demonstrated integrity, a learning culture and openness at the local level. However, the reason for the fall in reported incidents had not been reviewed.
The areas where the provider should make improvements are:
- Review training for physiologists and reception staff to include recognising sepsis and display a sepsis flow chart for staff at the reception desk.
- Review the incident reporting systems so that it is easy to identify which department the incident occurred in and, take steps to halt the reduction in incident reporting.
- Take action to ensure staff are clear about and compliant with all aspects of the infection control and prevention policy.
- Review best practice guidance and consider additional training and updating for cervical screening sample takers.
- Review health and safety protocols to ensure that, when required, there are distinct action plans to ensure the clinical areas are checked and monitored in keeping with best practice.
- The provider should consider supplying a substitute antibiotic in the emergency medicines kit until the recommended medicine becomes available.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care